Noninvasive Electrocardiomapping Facilitates Previously Failed Ablation of Right Appendage Diverticulum Associated Life-Threatening Accessory Pathway

2012 ◽  
Vol 24 (5) ◽  
pp. 583-585 ◽  
Author(s):  
MÉLÈZE HOCINI ◽  
ASHOK J. SHAH ◽  
HUBERT COCHET ◽  
PHILIPPE MAURY ◽  
ARNAUD DENIS ◽  
...  
Keyword(s):  
Accessory Pathway ◽  
Life Threatening

scholarly journals Pre-excitation pattern associated with accessory pathway related tachycardia: Case report

2010 ◽  
Vol 138 (9-10) ◽  
pp. 639-642
Author(s):  
Mirko Burazor ◽  
Ivana Burazor ◽  
Nebojsa Mujovic
Keyword(s):  
Ventricular Tachycardia ◽  
Diagnostic Tests ◽  
Accessory Pathway ◽  
Accurate Assessment ◽  
Wpw Syndrome ◽  
Conduction Pathway ◽  
Difficulty Breathing ◽  
Life Threatening ◽  
Mapping Techniques ◽  
Excitation Pattern

Introduction. Pre-excitation is based on an accessory conduction pathway between the atrium and ventricle. The term Wolff- Parkinson-White (WPW) syndrome is used for patients with the pre-excitation/WPW pattern associated with AP-related tachycardia. Case Outline. We present a 52-year-old man with severe palpitation, fatigue, lightheadedness and difficulty breathing. The initial ECG showed tachyarrhythmia with heart rate between 240 and 300/min. He was treated with antiarrhythmics (Digitalis, Verapamil, Lidocaine) with no response. Then, the patient was treated with electrical cardioversion and was referred to our Clinic for further evaluation with the diagnosis: ?Ventricular tachycardia?. During in-hospital stay, the previously undiagnosed WPW pattern had been seen. Additional diagnostic tests confirmed permanent pre-excitacion pattern (ECG Holter recording, exercises test). The patient was referred to an electrophysiologist for further evaluation. Mapping techniques provided an accurate assessment of the position of the accessory pathway which was left lateral. The elimination of the accessory pathway by radiofrequent catheter ablation is highly effective in termination and elimination of tacchyarrhythmias. Conclusion. Symptomatic, life-threatening arrhythmia, first considered as ventricular tachycardia, reflected atrial fibrillation with ventricular pre-excitation over an accessory pathway in a patient with previously undiagnosed WPW syndrome.

Atrial fibrillation and supraventricular arrhythmias

2021 ◽  
pp. 719-739
Author(s):  
Demosthenes G Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Cycle Length ◽  
Accessory Pathway ◽  
Atrial Arrhythmias ◽  
Supraventricular Arrhythmias ◽  
Acute Setting ◽  
Epidemiology Data ◽  
Life Threatening ◽  
Appropriate Therapy

The term supraventricular tachycardia (SVT) refers to atrial arrhythmias, including atrial fibrillation, atrioventricular nodal reentry, and atrioventricular reentry due to accessory pathway(s). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and with the potential exception of atrial fibrillation, most of them are usually, although not invariably, manifest as regular rhythms. They are usually intrusive, symptomatic, and anxiety provoking but not dangerous. However, depending on their cycle length and the patient's background, they could also be, rarely, life-threatening conditions. In the acute setting, consideration of epidemiology data, clinical presentation, and the 12 lead ECG can provide diagnostic clues for differential diagnosis between SVT and ventricular arrhythmias, and guide appropriate therapy.

Asymptomatic pre-excitation

ESC CardioMed ◽  
2018 ◽  
pp. 2100-2105
Author(s):  
Jonathan Chrispin ◽  
Hugh Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Symptoms ◽  
Accessory Pathway ◽  
Clinical Signs ◽  
Epidemiological Data ◽  
Population Based ◽  
Increased Risk ◽  
Pr Interval ◽  
Life Threatening ◽  
Electrocardiogram Ecg

Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.

Supraventricular tachyarrhythmias

2019 ◽  
pp. 277-287
Author(s):  
Matthias Wilhelm
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Accessory Pathway ◽  
Competitive Sports ◽  
Training Volume ◽  
First Line Therapy ◽  
Atrial Remodelling ◽  
Life Threatening ◽  
Supraventricular Tachyarrhythmias ◽  
Exercise Induced

Supraventricular tachyarrhythmias (SVTs) include atrial tachycardia (AT), atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entrant tachycardia (AVRT), atrial flutter (AFL), and atrial fibrillation (AF). The prevalence of SVT does not differ between athletes and the general population. An exception is AF, with a two- to eightfold higher prevalence in athletes, probably due to exercise-induced atrial remodelling. Symptoms of SVTs include palpitations, dizziness, weakness, and rarely syncope, and may impair athletic performance. Except for AF in the presence of an accessory pathway, SVTs are rarely life-threatening. For treatment of AT, AVNRT, AVRT, and AFL catheter ablation is generally preferred over lifelong anti-arrhythmic drug (AAD) therapy because of high rates of resolution. Reduction of training volume and AAD therapy should be attempted in athletes with AF. However, catheter ablation of AF may be the first-line therapy in athletes with severe symptoms. Most athletes with SVT can continue leisure-time activities and competitive sports.

scholarly journals Management of Young Athletes with Asymptomatic Preexcitation—A Review of the Literature

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 824
Author(s):  
Tomasz M. Książczyk ◽  
Radosław Pietrzak ◽  
Bożena Werner
Keyword(s):  
Literature Review ◽  
Sudden Death ◽  
Systematic Reviews ◽  
English Language ◽  
Accessory Pathway ◽  
Young Athletes ◽  
Manual Search ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Life Threatening

Introduction: The management of young athletes with asymptomatic preexcitation remains a challenge, regardless of the progress we have made in understanding the basis of condition and developing catheter ablation procedures. The risk of sudden death, however small, yet definite, being the first symptom is determining our approach. The aim of the study was to establish the current state of knowledge regarding the management of young athletes diagnosed with asymptomatic preexcitation, by conducting a literature review. Material and methods: A comprehensive literature review was completed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to English language publications using the following search terms: “asymptomatic” or “incidental” and “pre-excitation” or “Wolff–Parkinson–White” or “delta wave” and “athlete” or “sport”. The search was supplemented by hand review of the bibliographies of previous relevant systematic reviews. Results: The search resulted in 85 of abstracts, and the manual search of the bibliographies resulted in 24 additional papers. After careful analysis 10 publications were included in the review. In all but one of the presented papers, the authors used non-invasive methods and then either trans-esophageal or invasive EPS as a way to risk stratify asymptomatic patients. Evidence of rapid conduction through the accessory pathway was considered high risk and prompted sport disqualification. In the analysed reports there were combined: 142 episodes of the life-threatening events (LTE)/sudden death (SCD), of which 56 were reported to occur at rest, 61 during activity and no data were available for 25. Conclusions: athletic activity may impose an increased risk of life-threatening arrhythmias in patients with asymptomatic preexcitation; hence, a separate approach could be considered, especially in patients willing to engage in high-intensity, endurance and competitive sports.

scholarly journals Anesthetic Management of a Patient with Wolff-Parkinson-White Syndrome for Laparoscopic Cholecystectomy: A Case Report

2020 ◽  
Vol 58 (229) ◽  
Author(s):  
Kiran Kumar KC ◽  
Sundar Hyoju ◽  
Pawan Kumar Raya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Incidental Finding ◽  
Anesthetic Management ◽  
Accessory Pathway ◽  
Exertional Dyspnea ◽  
White Syndrome ◽  
Balanced Anesthesia ◽  
Life Threatening ◽  
Wolff Parkinson White Syndrome

Wolff-Parkinson-White syndrome, an electrophysiological disorder of heart caused by preexcitation of an abnormal accessory pathway,can either be asymptomatic or may present with palpitation or exertional dyspnea. We report a case of an asymptomatic 45-year-old male with incidental finding of Wolff-Parkinson-White syndrome posted for laparoscopic cholecystectomy under general anesthesia. The anesthetic management of these patients is challenging as they are prone to develop life-threatening tachyarrhythmia. Taking all the necessary precautions to prevent tachyarrhythmia, balanced anesthesia, rigorous monitoring and preparedness with necessary drugs and equipment to treat any complications is the cornerstone for positiveoutcome.  

scholarly journals Adenosine-induced ventricular fibrillation in a patient with supraventricular tachycardia

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Shu Yu Lee ◽  
Sohil Pothiawala ◽  
Chong Meng Seet
Keyword(s):  
Ventricular Fibrillation ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Structural Heart Disease ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Frequent Use ◽  
First Case ◽  
Raising Awareness ◽  
Life Threatening ◽  
Prolonged Qt Syndrome

Adenosine is frequently used for paroxysmal supraventricular tachycardia (PSVT) treatment in the emergency department (ED). Atrial and ventricular pro-arrhythmic effects of adenosine were described in the literature, but ventricular fibrillation (VF) secondary to adenosine administration was rarely reported (with an incidence of < 1%). Reported herein is the first case of a 72-year-old female patient who developed VF hemodynamic collapse after an intravenous administration of adenosine for PSVT treatment. She had no known pre-excitation or accessory pathway, nor any underlying structural heart disease or prolonged QT syndrome. Raising awareness of this potential life-threatening pro-arrhythmic effect of adenosine is important, given its frequent use for PSVT treatment in the ED.

scholarly journals Clinical and Demographic Characteristics of WPW Syndrome Attending Arrhythmia Clinic of NICVD

2014 ◽  
Vol 41 (2) ◽  
pp. 50-53
Author(s):  
MM Rahman ◽  
MMR Khan ◽  
N Kamal ◽  
AK Shamim ◽  
MS Akter ◽  
...  
Keyword(s):  
Antiarrhythmic Drugs ◽  
Demographic Data ◽  
Accessory Pathway ◽  
Atrioventricular Reentrant Tachycardia ◽  
Wpw Syndrome ◽  
Ventricular Response ◽  
Life Threatening ◽  
Study Population ◽  
Left And Right ◽  
Wolff Parkinson White Syndrome

Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway which predisposes patients to tachyarrhythmias and sudden death. Among patients with WPW syndrome, atrioventricular reentrant tachycardia (AVRT) is the most common arrhythmia, accounting for 95% of re-entrant tachycardias. It has been estimated that one-third of patients with WPW syndrome have atrial fibrillation (AF). AF is a potentially life-threatening arrhythmia. If an accessory pathway has a short anterograde refractory period, then rapid repetitive conduction to the ventricles during AF can result in a rapid ventricular response with subsequent degeneration to ventricular fibrillation (VF). The study population included a total of 255 patients in whom 175 (68.62%) were men and 80 (31.38%) were women. Demographic data and clinical characteristics are depicted in Table 1. Left and right WPW syndrome were existing in 70.59% and 29.41% of patients respectively. Documented narrow QRS SVT was present in 96.86%, broad QRS SVT was in 2.75% and AF was in 3.14% of patients. Antiarrhythmic drugs most frequently used were Digitalis, Metoprolol, Sotalol, Amiodarone and Verapamil DOI: http://dx.doi.org/10.3329/bmj.v41i2.18809 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 50-53

Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

1995 ◽  
Vol 53 ◽  
pp. 840-841
Author(s):  
Z. Hong Zhou ◽  
Jing He ◽  
Joanita Jakana ◽  
J. D. Tatman ◽  
Frazer J. Rixon ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
3D Structure ◽  
Structure Study ◽  
Herpes Simplex Virus 1 ◽  
Shell Proteins ◽  
Life Threatening ◽  
Infected Cells ◽  
Simplex Virus ◽  
Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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